American Journal of Epidemiology Original Contribution Pregnancy Disorders That Lead to Delivery before the 28th Week of Gestation: an Epidemiologic Approach to Classification
American Journal of Epidemiology Original Contribution Pregnancy Disorders That Lead to Delivery before the 28th Week of Gestation: an Epidemiologic Approach to Classification
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T. McElrath;J. L. Hecht;O. Dammann;K. Boggess;A. Onderdonk;G. Markenson;M. Harper;E. Delpapa;E. N. Allred
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作者：
T. McElrath;J. L. Hecht;O. Dammann;K. Boggess;A. Onderdonk;G. Markenson;M. Harper;E. Delpapa;E. N. Allred
流行病学家以各种方式将导致早产的多种疾病归类到怀孕28周之前。作者试图确定有助于指导如何对导致这种早产的疾病进行分类的特征。他们招募了1006名妇女，她们在2002年至2004年期间在美国的14个中心分娩了一个怀孕不到28周的活产单胎婴儿。每次分娩按表现分类：早产(40%)、胎膜早破(23%)、先兆子痫(18%)、胎盘早剥(11%)、宫颈功能不全(5%)、胎儿指征/宫内生长受限(3%)。使用因子分析(特征值？1.73)来比较标准化访谈、图表回顾、胎盘组织学和胎盘微生物学在呈现组中确定的特征，作者发现了两种广泛的模式。一种类型，以组织学绒毛膜羊膜炎和胎盘微生物恢复为特征，与早产、胎膜早破、胎盘早剥和宫颈功能不全有关。另一种以组织稀少和炎症为特征，但存在胎盘功能障碍的组织学特征，与先兆子痫和胎儿适应症/宫内生长受限有关。导致早产的疾病可分为两组：与宫内炎症有关的疾病和与胎盘异常有关的疾病。极端早产给家庭和社会带来的负担促使人们努力寻找减少这种疾病发生的方法(1-4)。一些流行病学家建议，如果不同的临床表现有共同的病因，那么将它们组合在一起可以最大限度地发挥流行病学研究的力量(5-7)，并可以推荐常见的治疗干预措施。其他人认为，在证据更有力之前，最好研究个别实体(2、8-10)。最后，一些人还不相信这两种方式都有好处(4)。我们对妊娠28周前以活产结束的妊娠进行了大型前瞻性研究，这使我们能够探索这些妊娠的临床定义亚组的异质性/同质性。除了有关产妇人口统计和临床特征的传统信息外，我们还收集了有关胎盘微生物学和组织学的详细信息。这些额外的数据提供了对分娩前存在的宫内状况的洞察，从而帮助我们对与极早产相关的先前状况进行分类。
Epidemiologists have grouped the multiple disorders that lead to preterm delivery before the 28th week of gestation in a variety of ways. The authors sought to identify characteristics that would help guide how to classify disorders that lead to such preterm delivery. They enrolled 1,006 women who delivered a liveborn singleton infant of less than 28 weeks' gestation at 14 centers in the United States between 2002 and 2004. Each delivery was classified by presentation: preterm labor (40%), prelabor premature rupture of membranes (23%), preeclampsia (18%), placental abruption (11%), cervical incompetence (5%), and fetal indication/ intrauterine growth restriction (3%). Using factor analysis (eigenvalue ¼ 1.73) to compare characteristics identified by standardized interview, chart review, placental histology, and placental microbiology among the presentation groups, the authors found 2 broad patterns. One pattern, characterized by histologic chorioamnionitis and placental microbe recovery, was associated with preterm labor, prelabor premature rupture of membranes, placental abruption, and cervical insufficiency. The other, characterized by a paucity of organisms and inflammation but the presence of histologic features of dysfunctional placentation, was associated with preeclampsia and fetal indication/intrauterine growth restriction. Disorders leading to preterm delivery may be separated into two groups: those associated with intrauterine inflammation and those associated with aberrations of placentation. The burdens on families and society associated with extreme premature delivery have prompted efforts to find ways to reduce the occurrence of this disorder (1–4). Some epidemiolo-gists suggest that, if different clinical presentations share etiologies, then grouping them together maximizes the power of epidemiologic studies (5–7) and can recommend common therapeutic interventions. Others feel that, until the evidence is stronger, it is best to study individual entities (2, 8–10). Finally, some are not yet convinced there is an advantage either way (4). Our large prospective study of pregnancies that ended with a livebirth before the 28th week of gestation allowed us to explore the heterogeneity/homogeneity of clinically defined subgroups of these pregnancies. In addition to the traditional information about maternal demographic and clinical characteristics, we gathered details about placental microbiology and histology. These additional data provided insight into the intrauterine conditions that existed prior to delivery, thereby helping us classify the antecedent conditions associated with extremely preterm delivery.